전 세계적으로 소아청소년의 비만증가 속도는 성인의 비만증가 속 도를 넘었다. 세계보건기구(WHO)에서는 비만을 21세기의 신종 전 염병으로 지목하고, 적극적으로 대처할 것을 권고하고 있다. 우리나 라도 소아청소년의 비만의 빈도는 10-19%로 점차 증가하고 있다. 국 민건강영양조사에 따르면 한국 소아청소년 비만 유병률은 1997년 5.8%, 2005년 9.7%, 2007년 10.9%, 2010년 10.8%로 10년 사이 약 2배 정도 증가하고 있고 특히 연령에 따라 비만도가 증가하여 고등학생의 5명 중 1명이 비만으로 보고되는 실정이다. 소아청소년기의 비만은 성인 비만으로 이어지고 대사증후군의 위 험도를 높인다. 대사증후군은 복부비만, 고혈압, 이상지질혈증, 당 불 내성 등의 요소들이 복합적으로 나타나는 질환으로 개인에게 여러 위험인자들이 다발성으로 발생하여 동맥경화성 심혈관계 질환과 제 2형 당뇨병의 발병 위험을 높이게 된다. 특히 사춘기의 비만은 성인 에서 질병의 이환 및 조기 사망위험을 증가시키며 이 시기에 시작된 대사이상은 성인기까지 지속되는 경향을 나타낸다. 따라서 비만 소 아청소년에서 대사증후군 발생 위험요소를 조기 선별하고 치료하는 것은 성인기 대사증후군을 예방하고 미래의 심혈관 질환을 감소시키 는 데 무엇보다 중요하다. 본 종설에서는 비만 소아청소년에서 대사증 후군의 진단 기준에 해당하는 위험인자와 대사증후군 발병 위험 예 측 정도를 살펴보고 대사증후군의 위험 인자 각각에 대한 독자들의 폭넓은 이해를 돕고자 한다.
Background:The increasing incidence of pediatric obesity has recently emerged as a social problem, and children's eating behaviors and nutritional statuses directly affect health.Obesity prevention and treatment must involve dietary life management.Despite the importance of specialized, accurate eating behavior and nutritional status evaluations of obese children, available study tools in Korea are lack.Methods: Obesity index, blood parameters, and nutrient intake were evaluated in 64 obese children (29 boys, 35 girls) at a university hospital childhood and adolescent obesity clinic; eating behaviors and nutritional statuses were evaluated using a recently developed and validated Korean nutrient quotient (NQ) for children. Results:The subjects' mean age was 9.7 ± 1.8 years, and the mean obesity index was 132.8% ± 17.2%.Moderate or severe obesity (P< 0.001) was significantly more frequent among girls.Nutrient intake analyses revealed insufficient intakes of fiber, calcium, potassium, vitamin A, and folic acid relative to recommendation.Protein and carbohydrate intakes were significantly elevated among boys and girls, respectively (P= 0.001 and 0.004, respectively).The overall mean nutrition quotient score was 59.6 ± 15.3.Diversity and practice scores were below average, and girls had significantly higher scores only in regularity (P = 0.037).Severely obese children had significantly lower moderation (P = 0.032), practice (P= 0.005), and mean total scores (P= 0.019) relative to normal weight children.Conclusion: Specialized nutrition evaluation and mediation are essential for child obesity management.The nutrition quotient might allow more efficient evaluation of obese children.
Background: Previous studies have shown that 17beta-estradiol activates AMP-activated protein kinase (AMPK) in rodent muscle and C2C12 myotubes and that acute 17beta-estradiol treatment rapidly increases AMPK phosphorylation possibly through non-genomic effects but does not stimulate glucose uptake. Here, we investigated whether 24-hour 17beta-estradiol treatment stimulated glucose uptake and regulated the expression of genes associated with glucose and energy metabolism through the genomic effects of estrogen receptor (ER) in C2C12 myotubes. Methods: C2C12 myotubes were treated with 17beta-estradiol for 24 hours, and activation of AMPK, uptake of glucose, and expression of genes encoding peroxisome proliferator-activated receptor γ coactivator 1α, carnitine palmitoyltransferase 1β, uncoupling protein 2, and glucose transporter 4 were examined. Furthermore, we investigated whether AMPK inhibitor (compound C) or estrogen receptor antagonist (ICI182.780) treatment reversed 17beta-estradiol-induced changes. Results: We found that 24-hour treatment of C2C12 myotubes with 17beta-estradiol stimulated AMPK activation and glucose uptake and regulated the expression of genes associated with glucose and energy metabolism. Treatment of C2C12 myotubes with the estrogen receptor antagonist (ICI182.780) reversed 17beta-estradiol-induced AMPK activation, glucose uptake, and changes in the expression of target genes. Further-more, treatment with the AMPK inhibitor (compound C) reversed 17beta-estradiol-induced glucose uptake and changes in the expression of target genes. Conclusion: Our results suggest that 17beta-estradiol stimulates AMPK activation and glucose uptake and regulates the expression of genes associated with glucose and energy metabolism in C2C12 myotubes through the genomic effects of ER. AMPK activation is suggested to improve glucose uptake by muscles, and phosphorylation of AMPK and its substrate acetyl-CoA carboxylase (ACC) increases fatty acid oxidation in metabolic tis-sues. 11,12 Previous studies have shown that 17beta-estradiol activates AMPK in rodent muscles 13-15 and C2C12 myotubes. 14,16 Moreover, acute (≤10 minutes) treatment with 17beta-estradiol rapidly increases Akt and AMPK phosphorylation possibly through non-ge-nomic effects but does not stimulate glucose uptake or enhance insulin sensitivity in skeletal muscles (rat soleus) ex vivo. 15 Here, we investigated whether 24-hour treatment with 17beta-es-tradiol stimulates glucose uptake and regulates the expression of genes associated with glucose and energy metabolism through the genomic effects of ER in C2C12 myotubes.
Review 서 론최근 체중 감량을 목적으로 고지방 저탄수화물 다이어트에 대한 관심이 커지고 있다.고지방 저탄수화물 식사요법은 케톤 식사요법으 로 알려진 ketogenic diet에
Insulin resistance in patients with diabetes mellitus may be aggravated by various causes, including infection, obesity, and medications known to affect insulin sensitivity. During pregnancy, insulin resistance can be the result of hormones secreted by the placenta. Blood glucose control during pregnancy is important in preventing obstetric complications including miscarriage, congenital malformations, and macrosomia. We report a case of severe insulin resistance in an obese diabetic pregnant woman whose one-day insulin requirements were up to 1,000 IU.
그동안의 연구에 의하면 규칙적 신체 활동은 사망과 이환의 위험 을 낮추고, 혈압, 혈당, 혈중 지질, 체질량지수 등 심혈관 질환의 위험 요인들과 관련이 있는 것으로 알려져 있다. 특히, 규칙적 신체 활동 은 대사증후군의 위험을 감소시키는 것으로 보고되어 있다. 반대 로, 비활동성은 사망의 주요 위험 요인이며, 심혈관 질환의 위험 요 인들과 부정적인 관련이 있다. 국제 보건 기구(WHO 2010)는 일주일에 150분 이상 중간 강도의 유산소 신체 활동을 성인에게 권고하고 있다. 그러나, 2013년 국민건 강영양조사 결과 만 19세 이상 우리나라 사람들의 중간 강도 신체 활 동 실천률은 걷기를 포함하여 47.2%로 나와 인구의 반만이 신체 활동 을 적절히 하는 것으로 조사되었다. 즉, 우리나라 사람들 중 절반은 신 체 활동이 부족한 상태이다. 그리고, 비활동성과 관련이 있는 비만, 대 신체 활동 빈도와 대사증후군의 관련성
Background: The previous obesity research studies suggested that it is necessary to analyze effect size of physical education on obesity prevention. The purpose of the present study was to investigate research trends on the impact of physical education on childhood and adolescent obesity. Methods: Initially, 295 studies were collected from research databases. The collected studies highlighted the relationship between physical education and obesity for various age groups. Finally, 39 studies were selected for an analysis of research trends based on the screening steps designed for the present study. Results: The results showed that research studies conducted in Korea had limited ranges of researcher majors, scale of participants, and duration of research compared to research studies in foreign countries. These results indicate that inter-discipline research activity and longitudinal study are not yet popular in Korea. The results of the meta-analysis show no significant change in variables related to obesity including body composition and medical conditions. Although individual studies reported a statistically significant change in participant conditions after physical education, the analysis of combined data shows that the effects of physical education on obesity were not meaningful. Conclusion: The present study suggests that it is necessary to design more practical physical education programs based on the theoretical background of contents and teaching strategies in order to improve the practicality of physical education programs for preventing and reversing obesity.
비만이란 체지방의 과도한 증가로 인해 대사이상이 유발된 상태이 며, 각종 성인병과 암 등의 주요 위험 요인이다. 비만의 위험 요인을 찾 기 위해 그동안 많은 연구들이 진행되어 왔고 생물학적인 지표들이 발견되어 왔지만 유전적인 인자는 몇몇 유전질환의 예를 제외하면 주 요한 비만의 위험요인이 아니고, 주요 비만위험요인인 생활습관에 대 한 조절자(effect modifier)로서 작용한다고 받아들여지고 있다. 생 활습관 중에서도 특히 식습관이 비만의 더 큰 위험 요인으로 작용하 는 것으로 알려져 있으며, 이에 따라 그동안 식습관 패턴에 대한 많은 연구들이 있었는데 아침 식사를 하는 경우와 하지 않는 군 사이에 비 만도의 차이를 보였다는 연구가 주목을 끌기도 했고, 12주간 진행된 실험적 임상연구에서는 하루 동안 동일한 칼로리의 섭취를 제한하더 라도 저녁식사보다 아침식사를 많이 하는 경우 인슐린저항성이 낮아 지고, 제2형 당뇨병 환자의 경우 당화혈색소가 더 낮아지는 등 대사적 이익이 있다고 보고하기도 했다. 미국의 경우 흥미롭게도 비만율이 계속 증가하고 있는 지난 40년 동안 아침식사를 하는 인구는 줄고 저녁식사량이 늘어났다. 우리나 라의 경우도 미국과 식사 패턴은 크게 다르지 않을 것이라 쉽게 예상 할 수 있다. 이에 본 연구는 지역사회 일반 인구집단에서도 저녁식사의 비중이 높은 경우 복부비만의 위험이 높은지 살펴보았고, 늦은 식사 비율에 따른 비만에 대한 1997년도에 미국의 국민건강영양조사 자료를 가지 고 시행한 코호트 연구와 달리 늦은 식사의 비율이 높은 경우 복부 비만의 높은 위험과 연관이 있다는 결론을 내렸다. 이에 대해 독자는 단면연구가 가진 한계를 지적한 반면, 다년도의 국민건강영양조사라 는 대표적인 자료를 이용하여 이런 단점을 극복하려 한 점을 높이 평 가하였으며, 저녁식사 및 야식에 영향을 줄 수 있는 가족구조, 외식 여부, 직업 등과 같은 변수에 대한 보정을 실시 하지 못한 것을 제한점 으로 지적하고, 이런 변수를 추가적으로 보정하고 종단적으로 살펴 볼 필요가 있다는 의견을 제시하였다. 독자의 의견에 전적으로 동의하며 소규모 실험 연구를 통해 밝혀 진 아침과 저녁의 식사비율과 대사효과 사이의 인과관계를 대규모 인 구집단에서 확인하기 위해서는 건강보험공단 표본코호트와 같은 다년간의 종단적 관찰 자료를 이용하여 살펴볼 필요가 있다. 그러나 이 자료에는 24시간 회상자료를 토대로 한 각 식사의 시간대별 열량 을 확인할 수는 없고, 다만 영양생활습관 평가도구라는 타당도와 신 뢰도 평가가 되어 있지 않은 식습관 평가도구만 있으며 이것조차 2009년부터는 생애전환기검진으로만 시행하여 연구하기에는 아직까 지 제한이 많이 있다. 하루 속히 국가건강영양조사와 같은 단면적 관 찰을 통한 자료들이 종단적으로 수집되는 날이 오기를 기대한다. 복부비만과 저녁식사 및 야식의 비율과의 관계 (대한비만학회지 2016;25:92-8)
Background: This study investigated the association between physical activity and body fatness with serum vitamin D level in older adults. Methods: A total of 233 older adults (39 men and 194 women) aged older than 65 years were voluntarily recruited from a local community. Physical activity was monitored using a uniaxial accelerometer. Body fatness was measured using a standardized protocol. Subjects were classified as sufficient ( > 30 ng/mL), insufficient (20-29 ng/mL), or deficient ( < 20 ng/mL) based on serum vitamin D level. Pearson correlation analyses were used to calculate bivariate correlations between variables. Logistic regression was used to determine the odds ratio of serum vitamin D inadequacy. Results: There were linear increases in physical activity parameters including daily steps (P < 0.001), low-intensity physical activity (P < 0.001), moderate-intensity physical activity (P < 0.001), and high-intensity physical activity (P < 0.001) and linear decreases in body fatness parameters such as body mass index (P = 0.039) and waist circumference (P = 0.020) across incremental vitamin D levels. Vitamin D level was positively associated with daily steps (P < 0.001), low-intensity physical activity (P < 0.001), moderate-intensity physical activity (P < 0.001), and highintensity physical activity (P < 0.001) and negatively associated with body mass index (P = 0.001), percentage body fat (P = 0.005), and waist circumference (P = 0.003). Compared to the active group (reference), the inactive group (P = 0.001) had a significantly higher odd ratio for serum vitamin D deficiency even after adjusting for age and sex (P = 0.002). Conclusion: The findings of this study suggest that physical activity and vitamin D supplementation should be promoted for healthy aging.
습관과 신체활동 습관은 성인기까지 지속되어 소아기의 건강 문제뿐 아니라 성인이 된 이후의 건강 문제에도 영향을 미치게 된다. 2012 년 학교건강검사 표본조사 결과에 의하면, 우리나라 초등학생은 10 명 중 약 3명만이 매일 채소를 섭취하는 반면, 절반 이상이 주 1회 이 상 패스트푸드를 섭취하였고, 3명 중 약 1명의 초등학생이 하루 2시간 이상 TV를 보고 있어 식습관과 신체활동 습관에 문제가 있었다. 이 는 소아 비만의 증가로 이어져 초등학생의 비만율은 2008년 11.0%에 서 2012년 14.2%로 꾸준히 증가하고 있다. 소아 비만의 예방 및 관리 를 위해서는 올바른 영양, 신체활동 및 생활습관에 대한 지속적인 교 육이 필요하다. 소아의 건강습관 개선과 비만 예방을 위한 학교, 가족, 지역사회 중 심의 많은 중재 프로그램들이 그동안 시도되었지만, 소아 비만 문제 를 해결하는 데에는 한계가 있어, 소아 비만 예방에 효과적인 또 다른 초등학교 4-6학년 학생의 비만 예방을 위한 스마트 폰 어플리케이션 개발
Background: It has not been determined which obesity index might be most appropriate to predict nonalcoholic fatty liver disease in Asian populations.This study aimed to evaluate the usefulness of the waist-to-height ratio in assessing patients with nonalcoholic fatty liver disease and to identify the optimal cut-off values useful for predicting nonalcoholic fatty liver disease.Methods: Receiver operating characteristic curve analyses were conducted in order to assess the accuracy of the waist circumference, body mass index, and waist-to-height ratio for detecting nonalcoholic fatty liver disease among 616 women aged 20 years or older.To evaluate the optimal value of anthropometric indices, the Youden J-index (sensitivity+specificity-1) was used.Results: The area under the ROC curve of waist-to-height ratio was highest among anthropometric obesity indices as follows: 0.776 (0.731-0.822) for waist circumference, 0.775 (0.728-0.822) for body mass index, and 0.792 (0.748-0.836) for waist-to-height ratio, respectively.Using a waist-to-height ration cut-off value of 0.49, the sensitivity and specificity for detecting nonalcoholic fatty liver disease were 72.3 % and 74.7%, respectively.Conclusion: These results demonstrated that the waist-to-height ratio may be a better obesity index for identifying individuals at risk for nonalcoholic fatty liver disease in Korean women.
Background: Peroxisome proliferator-activated receptor γ (PPARγ) plays a major role in adipocyte differentiation. Testosterone is well known for inhibiting adipocyte metabolism in men. To investigate the inhibitory mechanism of testosterone on adipogenesis, this study evaluated the effects of testosterone on PPARγ expression and activity in adipocytes using in vitro approaches. Methods: After differentiated 3T3-L1 adipocytes were treated with PPARγ agonist troglitazone and sex hormone testosterone, the effects of testosterone on troglitazone-induced triglyceride accumulation and expression of genes involved in adipogenesis were investigated. We also inves-tigated whether testosterone regulates troglitazone-induced PPARγ reporter activity in 3T3-L1 preadipocytes. Results: Testosterone decreased triglyceride accumulation in differentiated 3T3-L1 cells compared with the vehicle treated control group. Testosterone also decreased the expression of PPARγ mRNA as well as PPARγ dependent adipocyte-specific genes, such as adipocyte fatty acid binding protein and tumor necrosis factor α. Moreover, testosterone treatment inhibited triglyceride accumulation, and the expression of PPARγ and adipocyte-specific genes caused by troglitazone in differentiated 3T3-L1 cells. Testosterone decreased troglitazone-induced PPARγ reporter activity. Also, treatment with testosterone led to an inhibition of troglitazone-induced PPARγ reporter activity in PPARγ and androgen receptor (AR) expressed 3T3-L1 preadipocytes. Conclusion: These results suggest that testosterone interferes with the actions of PPARγ on adipogensis by an AR-dependent component. In addition, this study may have provided valuable molecular and biological insights regarding testosterone therapy in obese hypogonadal men.
role in cholesterol metabolism and that EGFR TKIs could be novel drugs for the treatment of hy-
The prevalence of obesity is rapidly increasing worldwide, and its complications such as type 2 diabetes and cardiovascular disease are also increasing. To avoid long-term damage caused by obesity and its complications, we must develop preventive measures and therapeutic agents based on the pathophysiology of human obesity. However, genetically-modified rodents are mainly used for obesity research. This type of animal model is not very suitable for the study of human obesity because environmental factors such as excessive food intake and sedentary lifestyle are major causes of the recent explosion in human obesity. Therefore, diet-induced obesity rodent models are more appropriate for research in human obesity. Type of diet, animal species, duration of food intake, age, and sex can play a role in determining body weight and levels of glucose, insulin, triglycerides, and leptin. Animal housing conditions such as the number of animals per cage, ambient temperature, and length of the light-dark cycle also influence body weight and metabolic parameters. As a result, many influencing factors should be considered in the development of an appropriate diet-induced obesity rodent model for successful obesity research.
Background:The purpose of this study was to investigate the association between number of sleep hours and obesity based on body mass index (BMI) after adjusting for socioeconomic position, health behaviors, and clinical factors.Methods: Data from subjects aged 20-64 years (n = 12,688) in the Korea National Health and Nutrition Examination Survey in 2007-2009 was analyzed.Subjects were divided into two groups according to age: 20-44 (young adults) and 45-64 years (middle-aged adults).With respect to sleep time, subjects were classified as short sleepers ( < 6 hr/day), long sleepers ( ≥ 9 hr/day), and normal sleepers (6-8.9 hr/day).Obesity was defined as a BMI ≥ 25.Results: The proportion of patients who were obese was 27.8%.The distribution of short sleepers, long sleepers, and normal sleepers was 6.4%, 13.7%, and 79.9%, respectively.The adjusted short sleeper and long sleeper odds ratios (OR) for obesity in young adults were significantly different from that in middle-aged adults after adjustment for confounding factors.In women, the adjusted short sleeper OR for obesity was 1.56 (95% CI, 1.02-2.37). Conclusion:This community-based random sample of Korean adults showed that women with short sleep duration may be at significant risk of obesity.
EunJin Kang, Su-Jin Moon, Kyung ho Moon, Deok-jae Han, Jain Lee, Sang Mi Ro, Jang-Won Son, Sung-Rae Kim, Jun-Ki Min, and Soon Jib Yoo. Korean J Obes 2016;25:150-3. https://doi.org/10.7570/kjo.2016.25.3.150
factors such as hypertension, glucose intolerance and dyslipidemia. Furthermore, obesity itself is an independent risk factor of heart disease. However, many studies and meta-analyses have shown that higher BMI correlates with better survival among patients with heart disease, known as the obesity paradox. In this review, the complex and disparate effects of obesity on heart disease and the evidence regarding pathophysiologic mechanisms of obesity-related heart disease will be discussed.
